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1 Wide-Complex Tachycardias in the ED: Myths and Pitfalls, FACEP, FAAEM Professor and Vice Chair Director, Emergency Cardiology Fellowship Department of Emergency Medicine University of Maryland School of Medicine Baltimore, Maryland OBJECTIVES At the conclusion of this presentation, each participant should be able to Identify difficulties in distinguishing amongst various types of wide complex tachycardias. 2. Describe pitfalls in the diagnosis and treatment of WPW-related tachydysrhythmias. 3. List the shortcomings associated with the use of amiodarone in managing patients with wide complex tachycardias.

6 AHA 2010 Guidelines for ACLS Procainamide Class IIa, amiodarone now Class IIb May cause hypotension (less often than procainamide), bradycardia, prolongation of QT interval Overall summary of amiodarone Dangerous in the setting of prolonged QT, pregnancy (Class D à may cause fetal hypothyroidism), rapid atrial fibrillation + WPW, AIVR and other slow VT conditions Not as effective as we had believed for stable VT Ineffective for VF (see below) V. Summary Assume all regular WCTs are VT. Response of a WCT to adenosine does not rule out VT. Look carefully for irregularity in WCTs (potential for atrial fibrillation with WPW); avoid adenosine and other AV nodal blockers! Amiodarone is not a cure-all for ventricular arrhythmias Dangerous in the setting of prolonged QT, pregnancy, rapid atrial fibrillation + WPW, AIVR and other slow VT conditions Not as effective as we had believed for stable VT. Procainamide should be considered the DOC for stable VT Caveats Avoid in torsades and type IA-type drug toxicities (prolongation of QT interval). When in doubt, cardiovert! Questions or comments? Please contact me: 6

Jordan M. Prutkin, MD, MHS Assistant Professor University of Washington 7/18/2013 What to do Check the patient s pulse Get an ECG Unless there s no pulse. Then call a code and do ACLS Approaching an EKG

Adding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT Introduction Before the year 2000, the traditional antiarrhythmic agents (lidocaine, bretylium, magnesium sulfate, procainamide,

AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support) The term cardiac arrhythmia

The ALIVE Trial: Versus In Pre-Hospital Refractory Ventricular Fibrillation Evaluation Based on preliminary data of Dorian P et al as presented at the 22nd Annual Scientific Sessions of the North American

American Heart Association ACLS Pre-Course Self Assessment Dec., 2006 ECG Analysis This pre-test is exactly the same as the pretest on the ACLS Provider manual CD. This paper version can be completed in

American Heart Association ACLS Pre-Course Self Assessment Dec., 2006 ECG Analysis This pre-test is exactly the same as the pretest on the ACLS Provider manual CD. This paper version can be completed in

American Heart Links There are several resources available to you on the American Heart Association website at www.americanheart.org. Here are some helpful kinks: You can find information on cardiovascular

Crash Cart Drugs Drugs used in CPR Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Introduction A list of the drugs kept in the crash carts. This list has been approved by the

2015 ACLS Review (877) 338-9286 www.cmrcpr.com FL PA NJ DISCLAIMER The following information is provided by the American Heart Association. Monies collected do not represent income for the American Heart

This course is designed to develop ECG recognition skills and drug treatment knowledge. An American Heart Association course completion certificate in ECG & Pharmacology will be awarded at the end of the

This is a SAMPLE of the pretest you can access with your AHA PALS Course Manual at Heart.org/Eccstudent using your personal code that comes with your PALS Course Manual The American Heart Association strongly

8 Peri-arrest arrhythmias Introduction Cardiac arrhythmias are relatively common in the peri-arrest period. They are common in the setting of acute myocardial infarction and may precipitate ventricular

Focus on CME at the University of Calgary Management of Cardiac Arrhythmias With many types of cardiac arrhythmias presenting in the clinical setting, family physicians must be able to distinguish each

Fetal and neonatal atrial flutter John Simpson Evelina London Children s Hospital Areas to be covered Fetal atrial flutter Means of diagnosis Context in relation to other fetal tachycardias Prenatal therapy

E C C American Heart Association ACLS Provider Written Examinations Contents: Examination Memo Version A Answer Sheet Version A Exam Version A Answer Key Version A Annotations Version B Answer Sheet Version

2012 ACCF/AHA/HRS Guidelines for Implantable Defibrillator and Cardiac Resynchronization for Cardiac Rhythm Abnormalities 1 Despite ICD and CRT being a Class I or IIa indication for treatment of patients,

ADVANCED CARDIAC LIFE SUPPORT (ACLS) RECERTIFICATION EXAMINATION 1. Ten minutes after an 85 year old woman collapses, paramedics arrive and start CPR for the first time. The monitor shows fine (low amplitude)

Guideline for the management of arrhythmias The following guideline is approved only for use at University College London Hospitals NHS Foundation Trust. It is provided as supporting information for the

Glossary of Cardiology Terms Ablation The removal, isolation or destruction of cardiac tissue or conduction pathways involved in arrhythmias. Algorithm A set of precise rules or procedures programmed into

PRACTICAL APPROACH TO SVT Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia CONDUCTION SYSTEM OF THE HEART SA node His bundle Left bundle AV node Right

Arrhythmia Facts During a 24-hour period, about 20% of healthy adults are likely to have frequent or multiple types of premature ventricular heartbeats. Heart arrhythmias are very common and nearly everyone

Basic Life Support & Automated External Defibrillation Check response Shake gently Ask loudly: Are you all right? If not responsive Open airway & check for breathing If not breathing normally or not breathing

EKG Interpretation Objectives Describe the electrical current of the heart Describe the basic approach to interpretation of ECG strips Explain the five steps used in interpretation of ECG strips Explain

BASIC CARDIAC ARRHYTHMIAS Revised 10/2001 A Basic Arrhythmia course is a recommended prerequisite for ACLS. A test will be given that will require you to recognize cardiac arrest rhythms and the most common

Cardiac rate control or rhythm control could be the key to AF therapy Recent studies have proven that an option of pharmacologic and non-pharmacologic therapy is available to patients who suffer from AF.

Patient information factsheet Tachyarrhythmias (fast heart rhythms) The normal electrical system of the heart The heart has its own electrical conduction system. The conduction system sends signals throughout

IU Health ACLS Study Guide Preparing for your upcoming ACLS Class REVISED SEPTEMBER 2011 ON APRIL 1, 2011 WE BEGAN TEACHING THE 2010 AHA GUIDELINES. WE HIGHLY RECOMMEND REVIEWING THE NEW ALGORYHMS FOUND

Episode 20 Atrial fibrillation Prepared by Dr. Lucas Chartier Most common dysrhythmia seen in ED, and incidence increasing with ageing population Presentation Common presentations: younger patients often

Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation

Tachyarrhythmias in the ICU ACNP/PA Critical Care Boot Camp Vanderbilt University Medical Center September 21, 2015 Ariel Kappa RN, MSN, ACNP-BC Acute Arrhythmias are the gremlins of the ICU because they

Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.

E C C American Heart Association Advanced Cardiovascular Life Support Written Exams Contents: Exam Memo Student Answer Sheet Version A Exam Version A Answer Key Version A Reference Sheet Version B Exam

Determining a new electrode configuration for a hand held ECG device when compared to the 12 lead ECG. AMY FAIRHURST STP TRAINEE CARDIAC SCIENCE CENTRAL MANCHESTER UNIVERSITY HOSPITALS Life Threatening